NASW Health Care Reform Roundup – December 16, 2009

Senate Continues Consideration of Health Care Reform

The Senate is currently debating health care reform legislation. Numerous amendments are pending and each will require 60 votes for passage, a high threshold for inclusion. NASW has mobilized its members on reproductive rights, coverage for routine patient care costs associated with clinical trials participation, and we anticipate further mobilization on other issues in the debate. Final passage may occur late this week, and reconciliation of differences with the House versions could extend into early 2010.

NASW has recently called on all of its members to contact their Senators to support the bill (H.R. 3590), and a link to our most recent action alert is here. NASW has written to Majority Leader Reid supporting the Senate reform bill, and a copy may be viewed on the NASW Web site.

NASW Supports Clinical Trials Amendment

On December 7, NASW sent a letter to Senators Sherrod Brown (D-OH) and Kay Bailey Hutchison (R-TX) in support of their amendment to H.R. 3590, the Patient Protection and Affordable Care Act. The amendment would require that all third-party payers cover routine patient care costs incurred by patients enrolled in clinical trials. The amendment will apply to all phases of clinical trials for cancer and other life-threatening illnesses.

Section 1307 of the House health care reform bill (H.R. 3200) authorizes clinical social workers eligible to participate under Medicare Part B to bill independently for services to Medicare Part A covered residents of Skilled Nursing Facilities (SNFs). The provision removes Part B-eligible clinical social work services from the Medicare SNF per diem rate and alternatively authorizes them to bill for them separately. This is a long-sought change by NASW that will provide parity recognition for the profession in a SNF setting and expand the availability of clinical social work services to SNF residents covered by Medicare Part A. The Senate version of health care reform legislation (H.R. 3590) does not contain a similar provision, meaning the difference between the two bills must be ironed out in conference committee on the health reform legislation. NASW will work with House and Senate offices to support the provision when conference committee consideration begins.

Medicare MD & MSW Fee Schedule Update

Clinical social workers that participate in Medicare Part B will have their payment rates protected against large cuts scheduled for 2010 if Congress acts quickly on legislation to repeal the flawed sustainable growth rate (SGR) formula, which determines outpatient payment rates in Medicare and TRICARE. The SGR formula is frequently inappropriately described as the Medicare “physician fee” formula, but it actually sets the rate of increase or decrease for all Medicare Part B independent practitioners, including clinical social workers. NASW supports legislation that would halt scheduled cuts in Medicare payments to clinical social workers and other health professionals and has urged Congress to adopt legislation to recalibrate how these payments are set each year. See NASW’s letter to Congress here.

Correcting the problem before the rate cuts go into effect on Jan. 1, is politically difficult due to the multi-billion dollar costs of correcting the formula. Current law requires large annual reductions in Medicare SGR determined fees, which include rates paid to clinical social workers. Congress has rejected several SGR bills this fall, but is expected to address the payment problem once it finishes work on health care reform. There is a real possibility that corrective legislation may not pass until sometime after the cuts go into effect on Jan. 1. In the past Congress has occasionally failed to enact the SGR payment legislation by the end of the year, but has later passed retroactive legislation that restores provider payment rates. Without congressional action, payment rates for Medicare physician and clinical social worker services will drop by 21 percent on January 1, 2010. NASW is continuing to work with coalition partners in support of an SGR remedy.

Appropriations Bill Funds Study on Mental Workforce Issues

This past weekend, Congress finished the annual appropriations bill for the federal FY 2010, Labor-HHS-Education spending bill, which is available here on the House Appropriations website. One item of special interest to the social work profession is the inclusion of $900,000 for the Institute of Medicine (IOM) to study mental health workforce needs focused on (1) a systematic analysis of the current and projected mental and behavioral healthcare needs of the American people, particularly for aging and growing ethnic populations; and (2) developing policy recommendations for achieving a competent and well-trained mental health workforce to address those needs. Congressional authors justified the study as necessary in light of the projected doubling of the aged population by 2030, new evidence of the importance of addressing mental health needs as part of effective chronic disease management, increased numbers of veterans with post traumatic stress disorder, improved diagnostic techniques, and implementation of the new federal mental health parity law. The study expands on IOM’s 2008 broader study on the geriatric workforce, which did not explore mental health workforce needs in depth. NASW worked with other mental health professional groups to support this funding in the new law, and plans to advocate vigorously for the representation of the social work profession in the work of the IOM.